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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Will Focus do?

Abstract

Ultrasound is an elegant method which provides insight into the patient. Focused cardiac ultrasound (FoCUS) includes a basic approach to the heart and inferior vena cava (IVC) by ultrasound. By only using the eye-balling method attending physicians can obtain important information for a better understanding of a patient’s pathophysiology. Obtained data can be used immediately and integrated together with other clinical data, which helps physicians in their decision-making process.

Key words: focused cardiac ultrasound, point of care ultrasound, physicians performed ultrasound, hemodynamic monitoring, shock, cardiac arrest

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Intensive care management of patients with left ventricular assist device

Abstract

Mechanical circulatory support devices, especially left ventricular assist devices (LVADs) represent an important treatment modality for patients with end-stage heart failure (HF). In a 1-year period (from January to December 2017) in our intensive care unit (ICU) we had a total of 8 patients with LVAD implantation. LVADs are devices with unique physiology which restore tissue circulation by increasing blood supply, nevertheless, they can be challenging to manage and are associated with significant complications.

Keywords: Critical Care, Heart-Assist Devices, Heart Failure, Hemodynamics, Hemodynamic Monitoring, Cardiac surgery, Postoperative Complications

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Assesment of hemodynamics by basic ultrasound

Abstract

Basic ultrasound can provide important information about the main parts of the circulatory system, the heart, and the main vessels. At the bedside, only by brief visual impression of the heart function and inferior vena cava diameter, and without any measurements, the attending physician can get important information which can influence the clinical opinion-making process and the management of the hemodynamically unstable patient. No less important is to obtain information about the lungs, particularly to estimate if extravascular lung water is present in excess or not. Ultrasound can help in the detection of the potentially reversible causes of hemodynamic instability or arrest and can guide the treatment. Examples are pneumothorax, cardiac tamponade, thromboembolism, the detection of blood in the pleural, pericardial or abdominal space after trauma and the detection and treatment of the source of the infection.

Key words: ultrasound, hemodynamic monitoring, shock

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Current practice of hemodynamic monitoring with PiCCO in a single general surgical ICU in a university hospital – a short report

Abstract

Background: In recent years, there has been an overall trend toward using less invasive hemodynamic monitoring in surgical intensive care units. The pulse contour cardiac output monitor (PiCCO) is one of them.

Objectives: The aim of this study was to evaluate our practice of hemodynamic monitoring with PiCCO in the perioperative period.

Methods: A retrospective descriptive analysis was performed in a single general surgical intensive care unit (ICU) run by anesthesiologists for the years 2013-2016. We collected information about patients, ICU quality parameters and monitoring equipment available in the ICU. The primary endpoint was the incidence of PiCCO use.

Results: Out of 2972 patients admitted to the general surgical ICU in a 4-year period, besides basic monitoring with electrocardiography (ECG), pulse oximetry and blood pressure monitoring, more than half of the patients received central venous catheterization (55.1%), less than the half invasive arterial catheterization (44.1 %) and only a small proportion PiCCO (0.91%). No patient received a pulmonary arterial catheter. Mortality rate was 7.47 %.

Conclusion: The use of PiCCO in our ICU is far below reported in literature. In the majority of cases, our anesthesiologists make clinical decisions based on measurement of central venous and invasive arterial pressure.

Key words: hemodynamic monitoring, intensive care unit, general surgery

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